- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,464.63 / $4,723.00 / $11,627.00
| Facility | | $1,464.63 | $4,723.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,315.00 / $7,711.57 / $14,996.00
| Facility | | $3,315.00 | $7,711.57 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.82 / $1,275.82 / $1,857.76
| Facility | | $1,275.82 | $1,275.82 | $1,857.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,904.00 / $5,998.00 / $9,245.00
| Facility | | $2,904.00 | $5,998.00 | $9,245.00 |